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BACKGROUND: Fatty acids synthesis and metabolism (FASM)-driven lipid mobilization is essential for energy production during nutrient shortages. However, the molecular characteristics, physiological function and clinical prognosis value of FASM-associated gene signatures in hepatocellular carcinoma (HCC) remain elusive. METHODS: The Gene Expression Omnibus database (GEO), the Cancer Genome Atlas (TCGA), and International Cancer Genome Consortium (ICGC) database were utilized to acquire transcriptome data and clinical information of HCC patients. The ConsensusClusterPlus was employed for unsupervised clustering. Subsequently, immune cell infiltration, stemness index and therapeutic response among distinct clusters were decoded. The tumor immune dysfunction and exclusion (TIDE) algorithm was utilized to anticipate the response of patients towards immunotherapy, and the genomics of drug sensitivity in cancer (GDSC) tool was employed to predict their response to antineoplastic medications. Least absolute shrinkage and selection operator (LASSO) regression analysis and protein-protein interaction (PPI) network were employed to construct prognostic model and identity hub gene. Single cell RNA sequencing (scRNA-seq) and CellChat were used to analyze cellular interactions. The hub gene of FASM effect on promoting tumor progression was confirmed through a series of functional experiments. RESULTS: Twenty-six FASM-related genes showed differential expression in HCC. Based on these FASM-related differential genes, two molecular subtypes were established, including Cluster1 and Cluster2 subtype. Compared with cluster2, Cluster1 subtype exhibited a worse prognosis, higher risk, higher immunosuppressive cells infiltrations, higher immune escape, higher cancer stemness and enhanced treatment-resistant. PPI network identified Acetyl-CoA carboxylase1 (ACACA) as central gene of FASM and predicted a poor prognosis. A strong interaction between cancer stem cells (CSCs) with high expression of ACACA and macrophages through CD74 molecule (CD74) and integrin subunit beta 1 (ITGB1) signaling was identified. Finally, increased ACACA expression was observed in HCC cells and patients, whereas depleted ACACA inhibited the stemness straits and drug resistance of HCC cells. CONCLUSIONS: This study provides a resource for understanding FASM heterogeneity in HCC. Evaluating the FASM patterns can help predict the prognosis and provide new insights into treatment response in HCC patients.
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Objective To investigate the changes and clinical significance of the expression of neutrophil gelatinase-associated li-pocalin(NGAL)and autophagy during different time of renal ischemia/reperfusion(I/R)injury in rats.Methods The rat renal I/R in-jury model was established,thirty male Wistar rats were divided by random number table method into sham operation group(Sham group)and I/R group,according to the different time of reperfusion after I/R injury,the I/R group was divided into 4subgroups:2h group,6h group,24h group,48h group.Blood,urine and renal tissue samples were collected at different time points,NGAL levels of blood and u-rineweredetectedbyenzyme-linkedimmunoadsordentassay(ELISA)method.Bloodureanitrogen(BU)and serum creatinine(SCr)were detected by automatic biochemical analyzer.Hematoxylin-eosin staining was used to detect the degree of histopathological injury and score the degree of injury.TdT-mediated dUTP nick end labeling(TUNEL)method was used to detect the apoptosis of renal tubular ep-ithelial cells;the expression of autophagy related genes LC3 and Beclin-1gene was detected by real-time quantitative polymerase chain reaction(RT-qPCR)method.Results The expression levels of NGAL in blood and urine were elevated in the 2h after I/R injury,and peaked at 6h of reperfusion,and showed a downward trend at 24h.BU and Scr values began to increase after the 6h reperfusion of I/R in-jury and peaked at 24h of reperfusion.TUNEL positive cells began to increase at 6h after I/R injury,the number of the highest was at 24h reperfusion of I/R injury.Hematoxylin-eosin staining showed that there were different degrees of swelling and necrosis of renal tubular epithelial tissue in all groups after I/R injury.The expression of LC3 and Beclin-1 gene began to increased after the 6h reperfusion of I/R injury and peaked at 24h of reperfusion.Conclusion The expression level of NGAL increased at the early stage of renal I/R injury in rats,which was earlier than the changes of BU and SCr levels,and could be used as a molecular indicator for early diagnosis of renal I/R injury.During the aggravation of renal I/R injury,the expression of NGAL was increased and autophagy was activated,which indica-ted that NGAL and autophagy played a certain role in the process of renal I/R injury.
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Objective:To investigate the status quo and training needs of general practitioner (GP) job-transfer training program in Hebei Province.Methods:An online survey with self-designed questionnaire was conducted on May 2019 through WeChat among 165 trainees in the General Practice Training Center of Hebei Province. A total of 165 questionnaires were distributed and 149 were valid with an effective rate of 90.3%. The contents of the questionnaire included the basic information of the trainees, the evaluation of the current training, and the needs of the GPs′ job-transfer training.Results:Among 149 participants, there were 131 (87.9%)from the secondary hospitals or above, 146(98.0%)with bachelor′s degree or above, and 128 (85.9%)with intermediate or above professional titles. The survey showed that 72.0%(67/93)thought the main reasons affecting participation in the training were busy work load and insufficient personnel, the main problems of training were too short training duration(45.2%, 42/93), the not focused training contents(38.7%, 36/93) and lack of practice(37.6%, 35/93). In the 149 trainees, 136(91.3%) thought that the most important contents should be standardized diagnosis and treatment of common diseases; 104(69.8%), 118(79.2%), 115(77.2%) and 98(65.8%) considered that the knowledge of prevention and health-protection, first aid, latest progress and chronic disease management were needed for training; 110(73.8%)and 80(53.7%)thought the mastery of clinical practice and basic theory were needed. And 57.7% (86/149)of the trainees believed that research training was needed, and there was significant difference in the demand for research training among participants from different work units and with different professional titles (χ 2=15.371,10.625,all P<0.05). The accepted training methods were case study(53.7%, 81/149) and practical work(37.6%, 56/149). For training duration, 43.6% (65/149) thought it should not exceed 6 months and 56.4% (84/149) preferred more than 1 year; there was a significant difference in demanded training duration among trainees from different work units, with different education background and professional titles (χ 2=16.225,6.243,25.966, all P<0.05). Conclusion:We need a multi-channel and multi-level training model to establish a better job-transfer training system for general practitioners, in order to meet different training needs and to improve the effectiveness of the training.
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The organ system-based teaching model integrates the morphology and function of various organ and system of human body, breaks the boundaries of disciplines, and avoids the duplication and disjunction between disciplines. With this model general practitioners can effectively and efficiently learn basic knowledge and clinical skills in the training. This article introduces the organ system-based teaching model and its application in general practice job-transfer training in China.
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Objective To survey the current status and training requirement of rural doctors in Hebei province.Methods A questionnaire survey was conducted among1 200 rural doctors selected from 11 cities of Hebei province by stratified sampling from October to December 2017.The self-designed questionnaire included general condition,job satisfaction,impact of medical reform policies,training needs of rural doctors.Results A total of 1 200 questionnaires were distributed and 1 170 valid ones were retrieved with a recovery rate of 97.5％.Among the 1 170 responders,there were 726 males(62.1％) and 444 females (37.9％);748 (63.9％) were aged more than 40 years;612 (52.3％) hold secondary school degree;826 (70.6％) had been working in the village for more than 10 years,and the overall job satisfaction rate was 30.8％ (360/1 170).Among all responders,73.8％ (864/1 170) worked in the standardized village clinics,and 72.0％ (842/1 170) were contracted with local residents as family doctors;52.8％ (618/1 170) responders believed that the reform policy improved the health care for villagers.In all responders,98％ (1 147/1 170)thought they needed training,93.6％ (1 095/1 170) had received training.The training contents they most needed werethe management of common diseases (904,77.3％),followed by medical humanities(650,55.6％)and first aid knowledge (492,42.1％).The influencing factors for training were lack of time,no energy (656,54.3％),lack of appropriate training forms (510,43.6％),economic reasons (476,40.3％) and so on.Conclusion The working status of rural doctors need to befurther improvedand the training need to be strengthened to increase their job satisfaction.
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Objective To investigate the clinical and imaging manifestations of benign and aggressive spinal osteoblastoma. Methods Seventeen patients with benign osteoblastoma (BO) and 18 patients with aggressive osteoblastoma(AO) from May 2004 to November 2015 diagnosed by orthopedic doctor and pathologist were analyzed retrospectively. Thirty four patients (17 BO, 17 AO ) underwent CT plain scanning, 26 patients underwent MRI. The follow-up time was 6 to 96 months, the postoperative recurrence rate was calculated. The continuous variables including the age, the duration of symptoms and the size of tumor were compared between AO and BO with the 2-tailed Student t test or Mann-Whitney U test. The categorical variables were compared between AO and BO with χ2test.A P value<0.05 was considered statistically significant. Results The age was significantly different between AO and BO [(29.82 ± 14.69) Y vs (19.76 ± 10.33)Y, P<0.05]. The duration of symptoms was significantly different between AO and BO [15(6,96)m vs 6(1,60)m, P<0.05].The size of tumor was significantly different between AO and BO [(4.01 ± 1.46) cm vs (2.08 ± 0.64) cm, P<0.05]. Neurological deficit was found in 2 patients with BO and 9 patients with AO, there was significant difference(P<0.05).In the BO group,the adjacent bone involved(n=3),the calcification of the lesion(n=17),intact bony cortex(n=17),the ill-defined sclerotic bone around the lesion(n=17),the edema of bone marrow and adjacent soft tissue around the lesion (n=11), and intense enhancement (n=2) were observed in BO. While in the AO group, there were 11 patients with adjacent bone involved. The calcification of the lesion (n=12),intact bony cortex(n=0), the ill-defined sclerotic bone around the lesion(n=11),the edema of bone marrow and adjacent soft tissue around the lesion(n=10), and intense enhancement (n=10) were observed in AO. The above imaging features of BO were significantly different from that of AO(P all<0.05).The sex distribution,the location of the lesion,preoperative ALP,the type of bone destruction,the signal intensity were not significantly different between BO and AO(P>0.05).The recurrence rate of AO(37.50%)was significantly different from that of BO (6.67%,P=0.04).Conclusion The clinical features including the age,duration of symptoms,neurological deficit contributed to differentiating BO from AO.The size of AO was bigger than BO,and AO didn't have intact bony cortex.In the AO group,there was less calcification in the lesion,less edema of bone marrow and adjacent soft tissue around the lesion.The post-operation recurrence of AO was higher than BO.
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Purpose To explore the CT and MRI manifestations of spinal solitary fibrous tumor (SFT) to improve the accuracy of imaging diagnosis.Materials and Methods CT and MRI manifestations of eight pathologically confirmed SFT were retrospectively analyzed.CT and MRI scan were performed in 8 cases.The location,shape,size,density/signal,margin,condition of the internal lesion,adjacent bone destruction and reinforcement characteristic were also analyzed.Results Of the 8 patients,4 cases were pathologically confirmed benign and the other 4 cases were malignant.6 cases showed trans-intervertebral foramen dumbbell shaped soft tissue masses,1 case showed lobulated soft tissue mass lying outside the invertebrate canal and 1 case showed long fusiform lying in intradural extramedullary of spinal canal.6 cases had adjacent bone swelling or osteolytic destruction,1 case had compressive bone defect,and 1 cases showed no obvious bone destruction.The tumor showed an equal/mixed density on CT scan.T1WI equal/low signal was seen in MRI scan.Equal/slightly higher T2WI signals were seen in 6 cases and mixed signals in 2 cases.All patients undergoing enhanced scan showed obviously inhomogeneous enhancement.Conclusion Spinal solitary fibrous tumors are lobulated or dumbbell shaped and growth clinging to or surround the dura mater.The feature of MRI signal is evident that T1WI is mostly equal/low signal and T2WI is usually slightly higher/equal signal,often accompanied by bone destruction.
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Background The alteration of dominance eye is associated with visual quality in patients with age-related cataract or after cataract-surgery.However,the study on the relationship of dominance eye shift with vision following cataract-surgery is lack.Objective This study was to observe the influence of age-related cataract and cataract surgery on ocular dominance in the elderly.Methods A serial cases-observational study was designed.Eighty-seven patients with age-related cataract were collected from December 2011 to April 2012 in Affiliated Eye Hospital of Wenzhou Medical University,and phacoemulsification combined with intraocular lens (IOL) implantation was performed in all the patients.The patients were grouped into binocular vision difference (best corrected distance vision) ≥2 lines group (42 patients) and ≤ 1 line group (45 patients) on the standard logarithmic visual acuity chart.The frequency and shift of dominant eye were determined by card-hole method or thumb method before operation and 1 day,1 week,1 month and 3 months after operation.The difference in the frequencies of dominant eye between before and after operation was analyzed with MecNmar test.Results The median of best corrected distance vision (LogMAR) was 0.40 (0.00-1.40) in preoperation and 0.00 (-0.08-0.30) in postoperation,with significant difference between them (Z=-9.481,P =0.000).In the binocular vision difference ≥ 2 lines group,the dominant eyes were 24 in the right eyes and 18 in the left eyes.The milder cataractous eyes were identified as dominant eyes in 33 (78.57％) patients and heavier cataractous eyes were determined as dominant eyes in 9 (21.43％) patients before operation.However,the right eye was evidenced as dominant eye in 31 patients and the left eye was in 11 patients after operation.In the 42 patients,dominant eye shifted from the left eyes to the right eyes in 10 patients and from the right eyes to the left eyes in 3 patients,and 4 patients presented an unstable change binocularly.In 45 patients of the binocular vision difference ≤ 1 line group,the dominant eyes were the right eyes in 27 patients and the left eyes in 18 eyes in preoperation ; while after operation,dominant eye altered form the left eyes to the right eyes in 3 patients and form the right eyes to the left eyes in 1 patient,and unstable change occurred in 5 patients.There were no significant differences in the frequency of dominant eyes between before and after operation both the two groups (group A:P =0.092 ; group B:P =0.727).Conclusions Age-related cataract impact on eye dominance.Dominance eye may occur alteration binocularly following cataract surgery,which is one of causes of visual discomfort.